Notice large R ventricle with bowing of septum into L ventricle on PSAX image above, along with hypodynamic heart in second picture.

Given patient’s current pregnancy with hypercoagulable state, no previous medical hx and sudden collapse, PE was high on differential list. When specifically questioned, family remarked that patient has been complaining R lower leg pain for past 3 days and SOB earlier in the day before ED presentation.

It was decided to give tPa to patient considering likely etiology with no absolute contraindications. Images below are post tPa.

No further bowing of septum. R ventricle has decreased in size compared to pre-tPa images.